CW: Talk of chronic illness, terminal illness and death
I have a lot of experience feeding people who are sick.
I took a year off of college to spend time with my step-mother, who was terminally ill with ovarian cancer. For most of a year, at the age of 20, our roles reversed and I found myself trying to take care of her, to help her be comfortable, and to push back against the seemingly inevitable weight loss that was her most apparent outward sign of her slow demise.
Four years later, my immune system called bullshit and tried to take me down, starting with my lungs. I was hospitalized for over a month, underwent 4 open-lung surgeries, and spent most of the next year taking first one medication then another, as we tried to figure out what was happening and how to stop it. I ended up on weekly doses of a chemotherapy drug, leaving me nauseous and weak at least two days every week for the next three years.
More recently, my mother has undergone two major surgeries, and for about a month after each one, she was unable to do the daily work to feed herself or her boyfriend. Suddenly, I was once again providing meals to folks with limited appetites and much-needed nourishment to enhance healing.
How do we feed someone when they have limited appetite? How do we make sure they are getting enough protein to heal injuries and enough nutrients for their bodies to do the difficult tasks set to them? I’m not a doctor, a registered dietician or any other kind of official expert, but I have a lot of personal experience, and when our lives give us these challenges, we need as much help and support as we can get. In the spirit of giving you my love and support in whatever challenging times you may face, here are my best strategies.
If nausea is an issue:
- Find ways to incorporate ginger into their meals or snacks. The ginger cookies below were my go-to snacks on my chemo days.
- Avoid strong smells. I couldn’t stand the smell of egg yolks for a few years there. Broccoli and Brussels sprouts were no-go’s, too. Cold or room temperature foods tend to have lighter smells and tastes than warm foods and may be more easily tolerated.
- Be cautious with added fats until you know how they are tolerated.
- Starchy carbs are easier on a sensitive stomach than more fibrous ones. Cooking vegetables breaks down some of the fiber and helps with digestion. Soft fruits like melons and pears may be easier to enjoy than crunchier ones.
If you need to maximize calories:
- This might be a hard one for folks with physique backgrounds or long dieting histories, but you need to unlearn your fat and carbohydrate-cutting strategies and reverse them. Add fats back into recipes. Buy and use full-fat dairy products. Whole eggs instead of egg whites. Include some fruits and veggies, but reduce it to perhaps 25% of the food volume. Add back easy-to-digest starchy carbs like breads, cereals, and tasty premade products.
- Include a wide variety of flavors and textures. We experience sensory-specific satiety, meaning we get full on one thing, but we find we have “room” for something else. Use that to your advantage and provide a small amount of 3-4 options instead of only one or two.
- Find ways for them to “drink” their calories–rich bone broths for soups, smoothies and protein shakes, salad dressings, condiments. Less chewing encourages more eating. No need for Gatorade or Pedialyte–water down some juice to about half strength to sip on throughout the day.
- Bring on the desserts! Whatever the person loves and would get excited about. When calories are the goal, all calories are good calories. Puddings, custards, and ice creams are especially easy to eat when we’re not feeling well.
When you need to support wound-healing:
- Prioritize protein and fresh fruits and veggies. Protein is essential for rebuilding tissues. Have some at every meal. Fruits and veggies provide essential micronutrients for complex healing processes. Vitamin C is an important example–it’s water-soluble, meaning your body doesn’t store it for later use. Getting sufficient daily vitamin C while healing may even help reduce scarring.
- Make sure they get enough calories (see above). I read somewhere (Mayo clinic, maybe?) that said we can burn 10% more calories just from healing from a major surgery or other injury.
A note about muscle preservation–healing from a major surgery or going through a grueling treatment plan can be exhausting and make regular physical activity difficult. And folks are more able to get back to being independent (or maintaining their independence for longer), if they can preserve their strength. This does not mean we need to push our loved-ones or ourselves to go to the gym and push big weights when sick. Walking, standing, and housework can be enough to maintain independence. Simple exercises like leg lifts, if tolerated, can help preserve at least some strength. If you’re coordinating care with a physical therapist, hopefully they will provide specific, appropriate exercises for the person to do. Plenty research suggests eating enough calories and protein are important for muscle preservation, but they aren’t enough if the person isn’t providing some kind of stimulus to the muscle. It’s not always possible, and we all need to know when it’s time to rest, but it’s a good thing to keep in the back of our minds if the long term plan includes remaining or returning to an independent life.
By it’s very nature, taking care of someone when they’re ill is an ever-changing task. Just when you’ve figured out how to adjust to one situation, something new will arise. Hopefully, over time that means things are slowly getting better. But even if it means doing the labor of helping someone have peace and comfort before they pass away, what that means will change as their needs change. This is hard work, and it can be very rewarding. When I was hospitalized for a month, my sense of well-being and comfort immediately improved when someone began to bring in homemade food for my meals. I felt like I could actually get well again, instead of subsisting on the meager and tasteless, mass-produced meals from the hospital cafeteria. Eating good food felt like it fed my body better while it fed my soul. That is the gift we are giving by feeding someone when they are unwell.
I have one resource to offer you on this topic. I found a copy of this cookbook at the library when I was trying to figure out how to keep my stepmother eating, and I found its recipes and tone very helpful: Cooking Well for the Unwell. If you have other evidence-based resources to offer up, please leave them in the comments below!
Cakey Ginger Cookies
This is a soft, pillowy cookie rather than a crisp one. When I was sick and on chemo, there were days that my stomach was so topsy-turvy, these cookies were the only thing I could eat. I made them lower fat to make them easier-still on the belly and with loads of ginger flavor. Ginger settles the stomach and has anti-nausea properties. Have a few with a cup of hot chamomile tea sweetened with honey, and someone might almost feel normal!
one. Place the rack in the middle of the oven and preheat to 350oF.
two. Lightly grease or line baking sheets with parchment.
three. Whisk together in a bowl:
3 cups all-purpose flour
1 cup whole wheat flour
1 1/2 tsp baking powder
1/2 tsp baking soda
4 Tbs. ground ginger
1 Tbs. ground cinnamon
1/2 tsp ground cloves
1/4 tsp salt
four. In a mixing bowl, cream together until lightened in color:
1 stick of softened butter
1 cup sugar
1/3 cup brown sugar
five. Add to the butter mixture and beat until combined:
2 large eggs
1/2 cup dark molasses
2 tsp. lemon juice
zest of one lemon
1/2 cup applesauce
six. Gradually add the flour mixture until dough is smooth and well-blended. Refrigerate dough for 15-30 min. until chilled to make easier to handle.
seven. Using two spoons, scoop and form walnut-sized pieces and form into rough 1-inch balls. Space 1 1/2 inches apart on the prepared baking sheet.
eight. Optional: press into the top some coarse sugar or chopped candied ginger. I topped mine with crushed sugar cubes this year. Pound (I use a wooden sauerkraut pounder, but a rolling pin should work, too) a few sugar cubes at a time on a cutting board and press a round of dough into the pile until a few stick. Place with be-sugar cubed side facing up on the parchment paper.
nine. Bake 14-16 minutes, or until the bottoms are golden and they’re mostly firm to the touch at the center of the cookie.
Yields 5 dozen 2-inch cookies. Recipe can easily be halved.